臺灣博碩士論文加值系統

本研究之目的旨在探討認知行為團體治療對ESRD患者身體症狀困擾、憂鬱、自我照顧自我效能及生活品質之成效。本研究採實驗設計法，於北部某醫學中心血液透析室，以方便取樣，選取符合選案條件之60名血液透析患者，依隨機方式分派個案至實驗組及控制組，每組各30人。實驗組患者接受八週認知行為團體治療策略，每週一次，每次120分鐘；控制組則僅接受單位一般照護。研究工具包括：身體症狀困擾量表、健康促進策略量表、貝氏憂鬱量表及生活品質量表。資料收集分前測及認知行為團體治療課程實施後一週內追蹤後測。研究資料以SPSS 10.0版套裝軟體進行建檔及統計分析。統計方法包括次數分布、百分比、平均值、標準差、卡方檢定、獨立樣本t檢定等方法來呈現研究結果。
研究結果顯示大多數ESRD患者有身體症狀困擾、自我照顧自我效能偏低、憂鬱的情緒、及生活品質低落的情形。研究結果顯示認知行為團體治療對ESRD患者之自我照顧自我效能（t=5.96，p＜0.001）、憂鬱（t=-3.81，p＜0.001）、及生活品質（t=2.9，p＜0.01）有顯著的改善。
本研究結果提供臨床護理人員照顧ESRD患者參考之護理模式，期能藉由認知行為團體治療訓練措施，改善患者之身體症狀困擾與憂鬱情緒，提昇患者之自我照顧自我效能與生活品質。

The purpose of this study was to examine the effectiveness of the cognitive behavior group therapy to somatic symptom distress, depression, self-care self-efficacy, and quality of life in patients with end-stage renal disease who were receiving hemodialysis treatment routinely. This research applies with the methodology of experimental design. Patients were selected using convenience sampling at hemodialysis unit of a major medical center in northern Taiwan. Sixty patients were randomly assigned into experimental and control group. Patients in the experiment group received cognitive behavior group therapy. The group therapy runs two hours per week for 2 months. Patients in the control group only received unit routine care. Instruments included the Somatic Symptom Distress Scale（SSDS）, Strategies Used by People to Promote Health（SUPPH）, Beck Depression Inventory（BDI） and Short Form 36（SF-36）. Data were collected at the pretest and posttest. Data were coded and analyzed by using the SPSS for Windows 10.0 edition software. The statistical methods included frequency distribution, percentage, mean, standard deviation, 2 and independent-samples t-test".
Descriptive data suggested that subjects had a high level of somatic symptom distress, a low level of self-care self-efficacy, a high level of depression and compromised quality of life. The results of this study demonstrated that patients in the experimental group significantly improved their levels of self-care self-efficacy (t=5.96，p＜0.001), depression (t=-3.81，p＜0.001), and quality of life (t=2.9，p＜0.01) more than patients in the control group. However, there were no significant differences in somatic symptom distress and mental component summary of quality of life between groups.
In conclusion, this study provided an interventional model of cognitive behavior group therapy for nurses who are taking care of patients with ESRD. Additionally, it may helps patients not only to improve self-care self-efficacy and quality of life, but also to decrease somatic symptom distress and depression.

目 錄
誌 謝 …………………………………………………………………………Ⅰ
中文摘要 …………………………………………………………………………Ⅲ
英文摘要 …………………………………………………………………………Ⅴ
目 錄 …………………………………………………………………………Ⅶ
第一章 緒論
第一節 研究動機…………………………………………………………… 1
第二節 研究目的…………………………………………………………… 3
第二章 文獻查證
第一節 末期腎疾病………………………………………………………… 4
第二節 末期腎病患者的身體症狀困擾…………………………………… 5
第三節 末期腎病患者的自我照顧自我效能……………………………… 7
第四節 末期腎病患者的憂鬱……………………………………………… 11
第五節 末期腎臟病患者的生活品質……………………………………… 15
第六節 末期腎臟病患者的心理壓力與疾病認知………………………… 17
第七節 認知行為團體治療………………………………………………… 20
第三章 研究方法
第一節 研究架構 …………………………………………………………… 34
第二節 研究假設 …………………………………………………………… 35
第三節 名詞界定 …………………………………………………………… 35
第四節 研究設計…………………………………………………………… 36
第五節 研究對象…………………………………………………………… 39
第六節 研究工具…………………………………………………………… 40
第七節 認知行為團體治療方案…………………………………………… 45
第八節 研究步驟…………………………………………………………… 48
第九節 資料處理與分析…………………………………………………… 51
第四章 研究結果
第一節 研究對象背景資料………………………………………………… 52
第二節 血液透析患者之身體症狀困擾、自我照顧自我效能、憂鬱及
生活品質之狀況…………………………………………………… 58
第三節 認知行為團體治療對身體症狀困擾、自我照顧自我效能、憂
鬱及生活品質之成效……………………………………………… 61
第四節 認知行為團體治療活動之評值與成效…………………………… 66
第五章 討論
第一節 研究對象社會人口屬性與治療相關之臨床資料等研究變項概述…70
第二節 探討有關ESRD患者之身體症狀困擾、自我照顧自我效能、憂
鬱情緒與生活品質之狀態………………………………………… 71
第三節 探討認知行為團體治療課程實施對身體症狀困擾、自我照顧自
我效能、憂鬱情緒與生活品質之影響成效……………………… 75
第六章 結論與建議
第一節 結論………………………………………………………………… 80
第二節 建議………………………………………………………………… 81
第三節 研究之限制………………………………………………………… 83
參考資料
中文部分 ………………………………………………………………… 84
英文部分 ………………………………………………………………… 86
附錄
附錄一 SUPPH作者同意書…………………………………………………… 92
附錄二 SF-36使用同意書……………………………………………………… 93
附錄三 血液透析病人自我照顧評量表……………………………………… 94
附錄四 實驗組參與研究同意書…………………………………………………96
附錄五 控制組參與研究同意書…………………………………………………97
附錄六 研究個案基本資料問卷…………………………………………………98
附錄七 身體症狀困擾量表………………………………………………………99
附錄八 健康促進策略量表………………………………………………………100
附錄九 貝氏憂鬱量表……………………………………………………………101
附錄十 SF-36生活品質量表…………………………………………………… 103
附錄十一 活動過程評價表………………………………………………………105
附錄十二 認知行為團體治療活動程序表………………………………………107
圖表目錄
Figure 2.1 Generic cognitive-behavioural framework………………………… 24
Figure 2.2 Problem-level component………………………………………… 24
Figure 2.3 Case-level component…………………………………………… 25
Figure 3.1 Conceptual framework…………………………………………… 34
Table 3.1 Research Design…………………………………………………… 37
Figure 3.2 SF-36 subscores…………………………………………………… 45
Table 3.2 Cognitive Behavior Group Therapy Guildline…………………… 46
Figure 3.3 The process of data collection…………………………………… 49
Table 4.1 The Demographic Data of the Study Group……………………… 55
Table 4.1 The Demographic Data of the Study Group（Cont’d）……………56
Table 4.2 The Disease Related Variables of the Study Group…………………57
Table 4.3 The Distribution of Scores of SSDS、SUPPH、BDI and SF-36… 60
Table 4.4 The Level of Depression of the Study Group……………………… 61
Figure 4.1 Pretest and posttest score of studied variables between groups……64
Table 4.5 Distribution of Pretest and Posttest of Variables Betwen Groups… 65
Table 4.6 Change Scores of Studied Variables Betwen Groups……………… 66
Table 4.7 Course Evaluation for Cognitive Behavior Group Therapy……… 69

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